Cushings & Thrombocytopenia

[lucybrown]

Hi - My baby Lucy, 12 yr old beagle, was diagnosed with Cushings 2 1/2 years ago and although it has been an up and down journey she is doing very well on trilo. Three weeks ago I took her to the vet with what I thought was an abscessed tooth but it turn out she has thrombocytopenia - a blood disorder where the platelets in the blood are destroyed and the blood does not clot. The treatment is high doses of corticosteroids. :( Just wondering if anyone has come across this before??

[Roxee's Dad]

Hi,
I would like to welcome you and Lucy. I am glad you found us and happy that you have been treating Lucy successfully with Trilo. That is always great news. :) I don't have any experience with thrombocytopenia, :( but there are many others here and someone may have experienced it or know something about it. Weekends are kind of slow, especially this being a holiday here in the U.S.

Hang in there I'm sure someone will be along to help you sort through this.

[Squirt's Mom]

Hi and welcome to you and Lucy! :)

Do you have a name we could use? "Hey you" is kinda impersonal, ya know? ;)

First, congrats on coping with Lucy's Cushing's for 2 1/2 years successfully! That is wonderful and will be of great comfort for many here to read.

I am not familiar with thrombocytopenia either. Sounds almost like a human hemophiliac condition. One of our members is a lab tech for humans and is a big help with things like this. We also have several nurses as members and they are invaluable, too. There's even a vet who has joined. Like John said, this is a holiday weekend so it may be really slow but don't give up.

Meanwhile, if you could give us as much of Lucy's medical history as you can that would be a big help. If you have copies of the recent labs and tests results, posting them along with the units of measurement (ug/dl, mnol/L, etc) and normal ranges that would be great. Also, her weight, any other meds or supplements she is on and what for...in other words just kinda catch us up with what has been going on with Lucy.

In a quick search I found the following links on thrombocytopenia. Several are out there on the immune and idiopathic forms but these didn't seem to be directed toward those forms. I noticed there are some other options for treatment VS the steroids.

http://www.petplace.com/dogs/thrombocytopenia-in-dogs/page1.aspx

http://www.vetinfo.com/dthrombo.html

http://www.pethealthcare.net/phclibrary/canine/Thrombocytopenia_i.pdf

I'm glad you found us and hope to learn more about you and Lucy soon.

Hugs,
Leslie and the girls

[AlisonandMia]

Hi and welcome from me too!:)

Looks like I'm "just down the road" from you (I'm in Brisbane).

I'm sorry to hear that your fellow has developed thrombocytopenia. Yes I believe we have had one or two Cushing's dogs who happened to develop that disease too and maybe one who had the condition "unmasked" when their Cushing's was treated with cortisol-lowering meds. I'm relying on memory here though....

It seems that when a dog with Cushing's develops or already has other some other serious condition that makes treating the Cushing's a problem then the Cushing's takes very much a back seat and sometimes (as with thrombocytopenia) the high cortisol levels of the Cushing's are even used to "treat" the other disease.

Do you know what the plan is for Lucy - are they looking at stopping the Trilostane and starting her on prednisone or some other corticosteroid and and then tapering the steroid back to see if the rising cortisol that will very likely occur when you stop the Trilo is treating the problem? Looking at the links that Leslie posted it looks like that sometimes the steroids are only needed for 4 - 6 weeks so maybe it will be possible to start cautiously treating the Cushing's again at some point?

Has Lucy been seen by an internal medicine specialist (IMS) or is your GP vet consulting with an IMS? It does sound like Lucy's is a complex case requiring complex management and that ideally an IMS would need to be involved.

Good luck and keep us posted.

Alison

[StarDeb55]

I'm the lab tech that has already been mentioned. Thrombocytopenia is a general term for a low platelet count. Platelets are a blood cell that is the first mechanism in the coagulation cascade that triggers the formation of a clot. When there is bleeding, the platelets become "sticky" adhering to each other, & to the site of bleeding, whether it's an injury, cut, etc. to form basically a "spider web" across the bleeding site. The blood proteins that are the blood clotting factors then begin the reaction that starts the formation of a clot, with the clot beginning to form across this "spider web". That's a very basic explanation of what a platelet is, & what it does.

There are 2 types of an autoimmune disease that cause the destruction of platelets, yielding a low platelet count. One is idiopathic thromocytopenia pupura, the other, thrombotic thrombocytopenia purpura. Idiopathic simply means that they do not know the exact source of the problem. I don't know about canines, but the thrombotic form, or TTP, can be life-threatening. ITP, the idiopathic form, is usually not life-threatening, but must be treated to avoid the potential of any serious spontaneous bleeding from any mucous membranes in the body. Mucous membranes include your gums, nasal passages, lining of your GI tract, to name a few. Unfortunately, the standard treatment for both types is a round of corticosteroids. I totally agree with what Alison has already told you that the thrombocytopenia is going to have to take the priority, & the Cushing's is going to have to be put on the back burner for now. Please let us know what your vet's treatment plan is.

Debbie

[lucybrown]

Sorry it has taken so long to get back to you all - what a week! Lucy has had x rays and ultrasound to rule out the big C, Thrombocytopenia often be an indicator of cancer. We have stopped the trilo for now and she is having high doses of corticosteroids and cyclosporine. Blood tests today have indicated that her platelet count has improved and her vet & specialist are very happy - interestingly her specialist has seen a case where he suspected long term use of trilo may have been triggered this condition but at the time he was unable to locate data to support his suspicions.
Lucy is very happy drinking heaps, thank goodness we don't have water restrictions, I forgot how much a non medicated cush pup drinks. Will keep you up to speed. It's great to have the knowledgeable support of fellow cush parents. Sue & Lucy

[Squirt's Mom]

Hi Sue,

Would love to hear about how Lucy is doing these days! Drop a line when you can, please. ;) I worry when we don't hear for a bit. :o

Hugs,
Leslie and the girls